MEMBERSHIP FORM

Member name(s): ____________________________________________________

___________________________________________________________________

Address: ___________________________________________________________

Phone: ______________________ E-Mail:_________________________________

Annual dues @ $20*, generally paid in December

TOTAL enclosed: $_____________

SEND FORM to:
Reed Blackman, Treasurer
1230 Meyer Street
University City, MO 63130

Okay to use E-Mail for newsletters and announcements?  ___YES   ___NO

Norwegian Society of Saint Louis was recommended to me by:_________________

My Heritage:_________________________________________________________

Interests and/or any other comments:

*: Dues are $20 per unit – individual or family. Future newsletters will go only to those who have paid dues. The club needs funds to reserve locations for our activities and to provide activities at low cost. We count on your interest and support for the club’s continuance. We would like to send communications by E-Mail if possible but will honor requests for regular mail from those who have paid dues.